Form II

[see rule 40]

[SINGLE APPLICATION UNDER SUB-SECTION (5) OF SECTION 45]

BEFORE THE AUTHORITY APPOINTED UNDER SUB-SECTION (1) OF

SECTION 45

OF THE CODE ON WAGES, 2019 (Central Act No. 29 of 2019)

…………………

Application No…………..of 20……….

Between…………………………………………………………..……Applicant

(Through employees concerned or registered trade union or Inspector- cum-

Facilitator

Address…………………………………..………………………………………

……………….

And

……………………….………………………………………………………………

…………………

Address………………………

The application states as follows:

(1) The applicant(s) whose name(s) appear in the attached schedule

was/were/has/have been employedfrom……………to………….

as……………...(category)in…………………….(establishment)

Shri/M/s………………………………………………..…engaged

in………….(nature of work) which is/are covered by the Code on Wages, 2019.

(2) The opponent(s) is/are the employer(s) within the meaning of section 2(l)

of the Code on Wages,2019.

(3) (a)The applicant(s) has/ have been paid wages at less than the minimum

rates of wages fixed for their category (categories) of employment(s)

under the Code by Rs…. …………..Per day for the period(s)

from………………………to……………………….

(b) The applicant(s) has/ have not been paid wages at Rs……………..

Per day for the weekly days of rest from to…

(c)The applicant(s) has/ have not been paid wages at overtime rate(s) for

the periodfrom…………………..to…..............

(d)The applicant(s) has/have not been paid wages for period

from………………to……….

(e)Deductions have been made which are in contravention of the Code,

from the wage(s) of the applicant(s) as per details specified in the

annexure appended with thisapplication.

(f)The applicant(s) has/have not been paid minimum bonus for the

accounting year……………..

(4) The applicant(s) estimate(s) the value of relief sought byhim/ them on

each amount asunder:

(a) Rs…….

(b) Rs…….

(c) Rs…….

Total Rs…….

(5) The applicant(s), therefore, pray(s) that a direction may be issued under

section 45(2) of the Code on Wages, 2019for;

(a) payment of the difference between the wages payable under the Code

and the wages actuallypaid,payment of remuneration for the days

ofrest

(b) payment of wages at the overtimerates,

(c) compensation amounting toRs………………………

(6) The applicant(s) do hereby solemnly declare(s) that the facts stated in this

application are true to the best of his/their knowledge, belief

andinformation.

Dated………….

Signature or thumb-impression of the

employed person(s), or official of a

registered trade union duly authorized or

Inspector- cum-Facilitator.

Note: The applicant(s), if required, may append annexures containing details,

with this application.